Healthcare Provider Details

I. General information

NPI: 1992033500
Provider Name (Legal Business Name): MERCY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4345 W MEMORIAL RD STE 110
OKLAHOMA CITY OK
73134-1702
US

IV. Provider business mailing address

4300 W MEMORIAL RD
OKLAHOMA CITY OK
73120-8304
US

V. Phone/Fax

Practice location:
  • Phone: 405-749-7099
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRACY ENLOE
Title or Position: CFO
Credential:
Phone: 405-752-3161